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ICMLPS - Urinalysis - April 4
Terms in this set (24)
number and size of solute particles in solution.
High specific gravity reflects good tubular resorptive function.
Low specific gravity in acute renal failure or oliguria may reflect tubular dysfunction.
wide normal range (4.5-8.0), but usually acid (5-6).
If urine is left for a while before testing, it may become basic.
UpH > 7.0 with UTI usually indicates urease-producing organism (Proteus mirabilis).
positive results will not appear in the urine until serum levels exceed 180 mg/dl.
Positive results do not necessarily indicate the presence of DM, since abnormality in tubular glucose reabsorption may occur.
False positive results may occur in the presence of large amounts of ASA, vitamin C or bacteria.
usually <150 mg/day or 8-10 mg/dl.
Normal proteins are albumin (filtered) and Tamm-Horsfall (secreted by the distal/collecting tubules).
Dipstick methods usually test for albumin only.
Therefore, if you suspect other proteins (i.e., myeloma protein), you should request specific tests (i.e., sulfosalicylic acid).
<1g = transient, postural, tubular, glomy
>3g/day = glomuerlar
F+ = macroscopic hematuria UpH>8
usually < 2RBC/HPF.
Results are reported as trace - 3+.
Hematuria will impart reddish color to the urine and can come from anywhere in the GU tract.
Causes may include trauma, tumors, stones, glomerulonephritis and pyelonephritis.
Hemoglobinuria will impart a smoky color and results from intravascular hemolysis, burns, transfusion reactions, etc.
Myoglobinuria can also give positive results for Hgb dipstick.
False negative results may occur in the presence of large amount of vitamin C.
products of fat metabolism (i.e., beta-HB acid).
Positive results may occur in diabetic ketoacidosis (DKA), starvation, anorexia, acute dieting and vomiting.
Results are reported as trace - 4+.
False-negative results may occur if urine is left for a while before testing.
results are reported as 1-3+.
False-negative results may occur if urine is left for a while before testing (bilirubin is unstable) or in the presence of vitamin C.
It may indicate abnormal liver function tests or biliary obstruction
a metabolic product of bilirubin formed by intestinal bacteria.
It may indicate abnormal liver function tests occurring with hepatitis.
Also, it may occur during hemolysis, but not in the presence of biliary obstruction (absence of bilirubin in the intestine for bacterial metabolism).
Therefore, dipstick positive results for bilirubin but negative for urobilinogen will strongly suggest biliary obstruction.
a screen for bacteria (usually gram-negative rods that reduces nitrate to nitrite).
False negative results may occur in the presence of vitamin C, yeast, and gram-positive bacteria and in vegetarians (low nitrate production).
indicates the presence of polys.
False positive results may occur with eosinophils and Trichomonas,
false negative with vitamin C and a large amount of albumin.
Red blood cells
They usually lyse in dilute, alkaline or "non-fresh" urine (they become "ghost" or "shadow" cells).
They crenate in hypertonic urine.
Changing the microscope focus causes RBCs to appear as black circles.
Unlike RBCs, yeast cells are ovoid, variable in size, have double contour and are frequently budding.
Dysmorphic RBCs: blebs, budding (dumbbell shape), and loss of central hemoglobin (better seen by phase contrast lenses). Seen in pt. with GN (passed through the nephron length).
White blood cells:
dull gray, characteristic granules and lobulations of the nucleus (0-4/HPF).
Renal tubular epithelial cells
slightly larger than WBCs and contain a large round nucleus (frequently eccentric).
They may be cuboidal, columnar or teardrop-shaped (or having tail-like projections).
Seen in pt. with ATN, exposure to heavy metals or aminoglycosides.
Oval fat bodies are tubular cells with lipid particles usually seen in patients with the nephrotic syndrome.
Transitional epithelial cells:
a normal component. If abundant, one should r/o tumor.
Squamous epithelial cells:
less than 1/HPF if the urine is a clean catch.
They usually indicate vaginal contamination.
the "envelope" (square with diagonal lines), colorless, varies in size.
Normal after ingestion of oxalate-rich foods (tomatoes, spinach, oranges, asparagus, garlic and rhubarb).
Can be seen in patients with calcium oxalate calculi, ethylene glycol intoxication and following the ingestion of large doses of vitamin C.
their presence could be normal, associated with gout, acute febrile illness, Lesch- Nyhan syndrome or tumor lysis syndrome.
hexagonal, colorless. symetrical
Present in cystinuria/cystinosis
Crystals in Alkaline Urine
Ammonium Magnesium Phosphates (Triple Phosphates, Struvite): the "coffin-lid."*. Usually associated with UTI by urease-producing organism (Proteus mirabilis, Klebsiella).
Amorphous Phosphate: granular particles of phosphate salts.
Concentrated urine Exercise/stress Proteinuria
Tubular: ATN or other tubular damage
Degenerating cellular casts
Heavy proteinuria/nephrotic syndrome
Advanced renal failure
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